What is swine flu/influenza A?

Swine flu is a disease with a mild course in the great majority of

cases. It is a virus disease. The virus is similar in swine flu and
seasonal flu (the flu of normal winters). Swine flu can produce fever,
headache, muscle pain, general malaise, nasal congestion, cough,
and sometimes digestive symptoms. Swine flu has the same
symptoms as seasonal flu.

How do people get infected?

Transmission is the same as seasonal flu, because it is transmitted
through the droplets that we emit when speaking, coughing or
sneezing. We name it as pandemic because there are many people
affected in many different countries. It is a new virus A and we have
no defence against it. But being very infectious does not means that
it is more severe.

About the diagnosis

There is a quick laboratory test for the diagnosis, but in the case of
the swine flu it has low sensibility, of about 35%. That means that
even if the test is negative, if you have flu symptoms you may have
swine flu (in more than half of the cases, 65%). And what is more
important, the advice for caring yourself will be the same in all types
of flu.
So the test is not useful for mild cases.

What can be the expected course of the flu?

Data coming from the winter season in the South hemisphere show
that most cases (around 95%) have mild or moderate symptoms.
The course of the disease might be more complicated in chronic
complicated patients (for example, inmunosuppressant diseases),
children under 6 month, or patients with some risk factors.

How to avoid infection?

Basic recommendations are:
1.- Frequent hand-washing (for example, we know that washing
hands ten times a day reduces the risk in 50%).
2.- Respiratory hygiene (for example, coughing or sneezing in
disposable paper handkerchief and washing hands later; coughing
or sneezing on your arm to avoid hand contact; avoiding physical
contact when the symptoms are obvious).
We do not know if the surgical mask avoids the spread of the
epidemic. It is only recommended for sick patients when they are in
contact with other people and for the persons who care for them.
It is unclear if the anti-virus (oseltamivir-Tamiflu® or zanamivir-
Relenza®) stop transmission. Some studies in institutions (as
nursing homes) and in family contacts have proved very small
benefits. Having in mind that it is a mild flu and these drugs have
side effects, the routine use is not recommended.
Seasonal flu vaccination is not effective for swine flu. New
vaccinations are not yet in the market. We know nothing about its
security and effectiveness. In the present moment there are reasons
for keeping calm in view of the number of people affected and
number of deaths.

What to do in case of symptoms?

As stated before, the swine flu symptoms are the same as the
seasonal flu. As the old adage says: “the flu last 7 days with
treatment and one week without it”.
Those people who have severe symptoms should contact their
doctor; for example, dyspnoea, breathlessness, chest pain, fainting,
sudden worsening of symptoms, or symptoms during more than
seven days. Children should contact their doctor if they are under 6
months, or have dyspnoea, breathlessness, or fever for more than
three days (72 hours).
Most people will have mild symptoms and they will obtain no benefit
from the doctor. On the contrary, the wrong use of health services
overwhelm them and difficult the correct care of severe flu patients
or severe cases in general. So healthy people with mild flu
symptoms can carry out their self-care in their own homes with good
hygiene and keeping themselves well hydrated and nourished.
When suffering from flu it is convenient to avoid crowded places
during the first five days. And please remember the
recommendations: do not cough without protection, and wash your
hand frequently.

If symptoms appear, is it necessary to take drugs?

Fever by itself is not dangerous. Treat it when there is general
malaise. Anti-virus drugs have not proven effective in infections by
seasonal flu; at most they decrease symptoms in less than one day.
And considering the swine flu we even lack any probe of efficiency.
For these reasons anti-virus treatment must be apply only to
patients suffering from complications or those who high risk of
suffering them. In previously healthy people the risk of side effect
can be bigger than the benefits.

What about pregnancy?

It is well known that pregnancy implies a small increase of the risk
for complications in either type of flu (seasonal or swine). Being
pregnant does not increase the risk of suffering from swine flu. In
case of symptoms it is recommended to contact their doctor.
Nevertheless the risk is still very low and a great majority of
pregnancies will have a healthy outcome.

Conclusions
During the swine flu pandemic there will still be myocardial
infarction, appendicitis, cardiac failure, diabetes, asthma attack,
psychiatry diseases, hip fractures, accidents and thousands of other
illness that require medical attention. It is important that patients
suffering from swine flu do not panic and overwhelm the system, so
hospitals and doctors can continue to treat all patients. For that, it is
essential to keep calm and have common sense and self-control in
all levels, patients, health professionals, decision makers, politicians
and the media.

To know more, some selected references:

1. Burch J, Corbett M, Stock C et al. Prescription of anti-influenza

drugs for healthy adults: a systematic review and meta-
analysis. Lancet Infec Dis. 2009;doi:10.1016/S1473-
3099(09)70199-9.
2. Ellis C, McEven R. Who should receive Tamiflu for swine flu?.
BMJ. 2009;339:b2698.
3. Evans D, Cauchemez S, Hayden FG. “Prepandemic”
immunization for novel influenza viruses, “swine flu” vaccine,
Guillain-Barré syndrome and the detection of rare severe
adverse affects. J Infect Dis. 2009;200:321-8.
4. Kitching A, Roche A, Balasegaran S et al. Oseltamivir
adherence and side effects among children in three London
schools affected by influenza A (H1N1), May 2009. An Internet
based cross sectional survey. Eurosurvillance 2009;29:1-4.
5. Jefferson TO, Demicheli V, Di Pietrantonj C et al. Inhibidores
de neuraminidasa para la prevención y el tratamiento de la
influenza en adultos
sanos. www.cochrane.es/gripe/revisiones/CD001265.pdf
6. Sheridan C. Flu vaccine makers upgrade technology and pray
for it. Nature Biotechnolgy. 2009;27:489-91.
7. Shun-Shin M, Thompson M, Heneghan C et al. Neuraminidase
inhibitors for treatment and prophylasis of influenza in children:
systematic review and meta-analysis of randomized controlled
trials. BMJ. 2009;339;b3172.
8. Simonsen L, Taylor RJ, Vibourd C et al. Mortality benefits of
influenza vaccine in elderly people: an ongoing controversy.
Lancet Infect Dis. 2007;7:658-66.
9. Smith S, Demicheli V, Di Pietrantonj C, Harden AR et al.
Vaccines for preventing influenza in healthy children.
Cochrane Database Syst Rev. 2008;(2):CD004879.
10. White N, Webster R, Govorkovs E et al. What is the
optimal therapy for patients with H5N1 infection? PLoS Med.
2009;6:e1000091.
11. CDC H1N1 Flu | Interim Guidance for the Detection of
Novel Influenza A Virus Using Rapid Influenza Diagnostic
Tests http://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm
12. Amantadine, oseltamivir and zanamivir for the treatment
of influenza Review of NICE technology appraisal guidance
5. http://www.nice.org.uk/Guidance/TA168
13. Facemasks and Hand Hygiene to Prevent Influenza
Transmission in Households A Randomized Trial. Benjamin J.
Cowling et al. Annals of Internal Medicine 2009; 151 Issue 7
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Hewak B et al. Physical interventions to interrupt or reduce the
spread of respiratory viruses: systematic review. BMJ 2008;
336: 77-80